| Abstract|| |
Background and Aim: The aim of the present study is to compare the effect of corticotomy versus prostaglandin E1 injection in human subjects on rate of tooth movement, anchorage loss and their effect on crest bone height and root length.
Settings and Design: Clinical interventional study. Split mouth design was used.
Materials and Methods: Study was done on 32 regular orthodontic patients. A volume of 100 mcg of prostaglandin E1 was injected on the right side once in 2 weeks and on the left side corticotomy was performed, and canine retraction was started on both sides simultaneously. The rate of space closure and anchorage loss was assessed with casts. The root length and crestal bone height changes were assed with IOPAs. The comparison of rate of tooth movement, anchorage loss, crestal bone height and root length changes between the sides were statistically analyzed using paired t-test.
Results: The average rate of space closure on right side was 0.36 mm/week with a standard deviation of 0.05 mm/week and on the left side average rate of space closure was 0.40 mm/week with a standard deviation of 0.04 mm/week. The difference between the rate of closure between the right side and left where found to be statistically significant (P = 0.003). The anchorage loss, the crestal bone height changes and root length changes were not statistically significant.
Conclusion: The rate of tooth movement was significantly more with corticotomies when compared with given dose of prostaglandin injection.
Keywords: Canine retraction, corticotomies, prostaglandin E1
|How to cite this article:|
Rajasekaran U B, Krishna Nayak U S. Effect of prostaglandin E1 versus corticotomy on orthodontic tooth movement: An in vivo study. Indian J Dent Res 2014;25:717-21
Orthodontic tooth movement is a result of biological response to mechanical force.  Rate of orthodontic tooth movement depends on the amount of force applied, type of force applied and the presence or absence of biologic modifiers that affect bone metabolism. , There are various mechanical means suggested in the orthodontic literature to move the teeth efficiently. ,, Different pharmacological agents are tried as biologic modifiers to alter the rate of orthodontic tooth movement. ,, Corticotomies are suggested in the orthodontic literature to hasten the rate of orthodontic tooth movement. ,, The aim of the present study is to compare the effect of corticotomy versus prostaglandin E1 injection in human subjects on rate of tooth movement, anchorage loss and their effect on crest bone height and root length.
|How to cite this URL:|
Rajasekaran U B, Krishna Nayak U S. Effect of prostaglandin E1 versus corticotomy on orthodontic tooth movement: An in vivo study. Indian J Dent Res [serial online] 2014 [cited 2019 Oct 13];25:717-21. Available from: http://www.ijdr.in/text.asp?2014/25/6/717/152170
| Materials and methods|| |
This study was conducted in AB Shetty Memorial Institute of Dental Sciences, with the Institutional Ethical Committee approval. In this study, split mouth design was used. The study was conducted over a period of 2 years with each patient entering the study at different point of time.
A 32 regular orthodontic patients requiring first premolar extractions both on right and left side of the maxillary arch were selected from Orthodontic Department of AB Shetty Memorial Institute of Dental Sciences. The criteria for selection are as follows.
The final sample consisted of 17 male and 15 female patients. The mean age of the patients was 20.5 years. All the cases were prepared so that at the beginning of the canine retraction arches are aligned, tight maxillary interproximal contacts existed between canines and lateral incisors, second premolars and first molars, and first molar and second molar. The amount of spaces existed at the extraction sites at beginning of canine retraction was not the same in each individual patients space ranged between 7.5 mm and 4 mm. The amounts of the extraction space on right and left side were not equal at the beginning of the canine retraction.
- Medically uncompromised healthy patients with age range of 18-24 years with healthy periodontium and no missing teeth (except third molars) in maxillary arch
- Willing to undergo corticotomy and prostaglandin injection
- Tight maxillary interproximal contact before beginning of canine retraction between canines and lateral incisors, second premolars and first molars, and first molar and second molar.
The sequence of treatment:
Pretreatment records obtained, willingness of the patient for the experiment was obtained, first premolars extracted
Brackets placed, cases prepared to satisfy the study criteria before canine retraction
NiTi wire placed for brackets alignment till 17 × 25 full arches were able to engage the slots, lace backs were used
IOPA of canine obtained using paralleling technique, and precanine retraction models were made.
Step 4: Corticotomies performed
Canine retraction begin as described below, and weekly models were made and prostaglandin injections once in 2 weeks were given till completion of canine retraction
At end of canine retraction IOPA of canine obtained using paralleling technique 3M TM 022 stainless steel brackets with MBT prescription were used. The first molars were banded with first molar tubes. A 17 × 25 stainless steel wire consistently designed with a tip back bend to augment the anchorage on molar segment along with antitipping bend in the canine to prevent the tipping of canine along with antirotational bends was used [Figure 1]. The retraction force was applied with NiTi coil spring in such a manner the average force applied for complete canine retraction was in the range of 100 g [Figure 2]. The anterior teeth from the right side lateral incisor up till left side lateral incisor were ligated to prevent their movement during canine retraction [Figure 3]. Prostaglandin E1 injection (ALPOSTIN)® [Figure 4], containing prostaglandin E1 at a concentration of 500 mcg/ml of the injection was used. A volume of 0.2 ml of the injection was injected once in 2 weeks on the buccal side adjacent to the right canine from the beginning of canine retraction. Surgeries were performed with local anesthesia after raising a conventional full thickness flap [Figure 5] with an intra sulcular incision and using surgical bone cutting bur on slow speed with coolant. A vertical bony cut limited to the cortical bone on the buccal, and palatal surfaces adjacent to the distal canine root was performed [Figure 6]. Flap was closed with silk sutures. Canine retraction forces were applied after 8 days at the time of suture removal.
|Figure 1: Wire component made of 17 ss × 25 ss wire for augmenting molar anchorage and prevention of tipping and rotation of canine during retraction|
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|Figure 2: The canine retraction mechanical setup with wire component and NiTi coil springs|
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|Figure 3: Ligating the incisor segment to prevent their movement during canine retraction|
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At the beginning of the canine retraction, casts were made. The amount of space between second premolar and canine (site 1) and between canine and lateral incisor (site 2) for both right side and left side were measured using leaves of a leaf gauges and digital calipers to an accuracy of 0.05 mm and recorded as measurements at week 0. The canine retractions were started simultaneously on both right and left quadrant after performing corticotomy on the left side and injecting prostaglandin on the right side. The patients were recalled on a weekly basis and casts were made and 0.2 ml of prostaglandins were injected on the right side once in 2 weeks (week 0, week 2, week 4…) while nothing other than maintaining the force being done on the left side till complete closure of the extraction sites. The measurements at site 1 and site 2 on both right side and left side on weekly basis till complete closure of the extraction site were recorded on data collection forms for all 32 patients individually. IOPA taken at the end of space closure for measurement of root length and crest bone changes as measured from crown tip. On the IOPAs, mesiodistal width and height of the canine brackets in pre- and post-retraction radiograghs were measured and was equated with the original bracket dimensions for the purpose of calibration of IOPAs.
| Data processing and analysis|| |
Null hypotheses assumed and tested were:
Calculation of rate of space closure
- No difference in rate of space closure and anchorage loss following alveolar corticotomy or Prostaglandin E1 injection (tested using paired t-test)
- No difference in alveolar crestal bone loss or root length change following orthodontic tooth. Movement along with alveolar corticotomy or prostaglandin E1 injection (tested using paired t-test).
Initial amount of space at site 1 at week 0 divided by the number of weeks at the space at site 1 becomes 0 mm.
Calculation of percentage of anchorage loss
Initial amount of space at site 1 during week 0 minus amount of space at site 2 at end of canine retraction divided by the initial amount of space at site 1 during week 0 then multiplied by 100.
| RESULTs|| |
The average time for completion of canine retraction was 15 weeks on the right side with a range between 10 and 18 weeks and on the left side average being 13 weeks and range between 11 and 17 weeks. This was directly related to the amount of space existed at site 1 at the beginning of the experiment. The average rate of space closure [Table 1] on right side was 0.36 mm/week with a standard deviation of 0.05 mm, with highest and lowest being 0.40 mm/week and 0.26 mm/week respectively and on the left side average rate of space closure was 0.40 mm/week with a standard deviation of 0.04 mm, with highest rate being 0.45 mm/week and lowest rate being 0.32 mm/week. The difference between the rate of closure between the right side and left where found to be statistically significant (P = 0.003). On average, 19.33% of space (anchorage) was lost on the right side and 19.35% of space was lost on the left side, this space loss between right and left sides were not statistically significant (P = 0.67) [Table 2]. The average amount of crestal bone loss was 0.2 mm on the right side with the range being 0.2 to 0.5 mm in comparison to 0.2 mm on the left side with range being 0.2 mm to 0.3 mm. The average amount root length loss was 0.5 mm on right maxillary canine with range being 0.2 mm to 0.6 mm in comparison with 0.4 mm on left side canine with range being 0.1 mm to 0.5 mm. The amount of alveolar bone loss and root length loss between sides were not statistically significant (P = 0.08) [Table 3].
| Discussion|| |
None of the procedures resulted in a constant rate of space closure that will be applicable to all patients for the particular procedure. The variation in the rate of tooth movement among individuals is also supported by some of the previous studies. ,, The amount of anchorage loss occurred in our study is almost similar to the amount of anchorage loss when molar served as anchorage unit for canine retraction in the previous study.  This suggests neither of the procedures is more hazardous for anchorage than none of these procedures.
The increased rate of space closure on the corticotomy side compared to prostaglandin side can be explained by the regional acceleratory phenomenon, decreased mineral content of the bone following selective alveolar decortication and may be due to limited use of the surgical side by the patient causing a viscous cycle between chewing pattern and bone density. ,
The prostaglandin E1 have both systemic and local effects. , The local effects on bone by Prostaglandin as described by norddin  can be attributed to the effect of prostaglandin on tooth movement. The dose of prostaglandin E1used in our study was chosen after considering the safe dose of prostaglandin E1 in human adults for other medical purposes along with the previously used prostaglandin dose in animal experiments and human experiments for the purpose of enhancement of tooth movement as published in medical and orthodontic literature. ,,,
On the side of the corticotomy, the patients complained of mild swelling and pain during the 1 st week consistent with most of the oral surgery procedure and on the side of prostaglandin injections patients complained of pain at times of injections and most of them complained that the pain was severe and persisted up to 3 days from the time of injection. The chairside time required for injection of prostaglandin was < 2 min at each appointment while time required for corticotomy was about 20 min only once at the beginning. There were no notable changes of the oral mucosa on both sides at clinical level.
The force magnitude used in our study was based on optimum force for canine retraction as published in the previous studies on canine retraction.  We used leaf gauge and digital calipers because during initial stages of space opening at site 1 was difficult to measure with calipers alone. Even though various methods are used in previous canine retraction studies. , For measuring the amount of space opening and the amount of space closing, leaf gauge, and digital calipers were used because it helped us to measure the spaces more directly from the beginning of the experiment. We used paralleling technique IOPAs as they were more reproducible and had less distortion.  Further the radiograghs were calibrated by measuring the mesiodistal width and height of the canine brackets in pre and postretraction radiograghs and was equated with the original bracket dimensions.
In our study, we used purposive sampling and no blinding was done in sampling stage. The possible bias that would arise during the measurement of amount of space opening and closure as well as root length and crestal bone changes between right and left sides were addressed by measuring on the coded casts and IOPAs, each measurement was made on the cast and IOPAs respectively at two different occasions by the first author and if the discrepancy between the first observation and second observation existed the measurement was redone by the second author for the particular data and it was entered on the final data collection form for each individual patients. The blinding and randomization of IOPAs and casts were done. The amount of marginal bone loss and root length loss were less than in previous studies  and could be attributed to the reduction in treatment time or due to the difference in methodology.
| Conclusion|| |
At the present dosage of 100 mcg once in 2 week (0.2 ml of 500 mcg) of local administration of prostaglandin E1, all other factors being equal the corticotomy proves to improve the rate of tooth movement better than prostaglandins.
- Both the procedures do not affect the crestal bone level or the root length
- Both the procedures do not cause any undue anchorage loss.
| Acknowledgment|| |
Help in literature search Dr. US Arjun Nayak PG Student, Department of Orthodontics, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India.
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U B Rajasekaran
Department of Orthodontics, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3]